P1095: TREATMENT ATTRIBUTES FOR 3RD LINE FOLLICULAR LYMPHOMA TREATMENT DECISION-MAKING: PHYSICIAN PERSPECTIVES FROM A SURVEY ACROSS WESTERN EUROPE AND THE UNITED STATES
Authors: P. C. Johnson, A. Bailey, N. Milloy, E. Clayton, R. G. Quek, Q. Ma
Journal: HemaSphere (2022)

Background: Follicular lymphoma (FL) is the second most common subtype of non-Hodgkin lymphoma (NHL), and is the most common of the clinically indolent NHLs. Treatment (tx) selection must integrate a myriad of clinical and patient factors, including disease resistance, cumulative toxicities and treatment efficacy, as well as patient quality of life (QoL) and the costs of therapies. However, real-world data regarding physician perspectives on tx selection is lacking, especially at later lines of therapy. Aims: This study aims to assess physician perspectives regarding key tx selection attributes including those beyond efficacy and safety, as well as physician perception of patient’s tx preference, when selecting a 3rd line (3L) FL tx. Methods: Descriptive data were drawn from the Adelphi FL Disease-Specific Programme™, a point-in-time study that was fielded June 2021-Jan 2022. Haematologists, haem-oncologists and medical oncologists (med-onc) in EUR [France, Germany, Italy, Spain, United Kingdom (UK)] and the US completed online surveys regarding self-reported demographics and the top 7 tx attributes contributing to their rationale for 3L FL tx selection from a comprehensive prespecified list of 28 attributes derived from expert opinions. Physicians also provided their perception on patient’s preference regarding tx attributes for choosing 3L tx. Results: Of 251 physicians surveyed in EUR (France: n=46; Germany: n=40; Italy: n=43; Spain: n=41; UK: n=31) and the US (n=50), 49% were haem-oncologists, 41% haematologists and 10% med-oncs. 52% primarily worked at academic hospitals. Progression free survival (74.1%), overall survival (70.1%), duration of response (59.8%), evidence-based efficacy overall / overall response rate (57.4%) and ability to achieve complete response (46.2%) were most frequently physician reported top 7 attributes for 3L tx selection. Notably, long-term safety and impact on patients’ QoL were reported by 38.6% and 34.3% of physicians, respectively. Fewer physicians reported cost (4.8%), patient acceptability of lag time between leukapheresis and CAR-T infusion (7.2%), patient acceptability of frequency of administration (8.0%), less monitoring needed (8.8%) and fewer outpatient / inpatient consultations needed (5.6% and 7.6% respectively) as their top 7 3L tx attributes considered. Frequency of some 3L tx selection attributes reported differed substantially between EUR and the US including long-term safety (35.8% vs 50.0%), impact on patients’ QoL (37.8% vs 20.0%), and suitability for patients aged over 60 years (10.9% vs 22.0%). Summary/Conclusion: Treatment efficacy and improved survival were the most important attributes for physicians’ 3L FL tx selection whilst safety, impact on patient QoL, frequency of inpatient / outpatient consultations, monitoring requirements, and cost were amongst those attributes considered less important by physicians. Despite literature indicating that patient QoL and cost of tx should both be key considerations for physicians when choosing FL tx, our study highlights these are less commonly reported attributes for treatment selection. Future study is warranted to further explore reasons for physician treatment selection.